Current Quality Measures Research Articles

Teaching Quality: An Unexamined Element of Special Education Teacher Turnover

Little is known about the quality of the special educators who move schools, switch to general education, or leave teaching. In this study, the author examined if turnover (moving schools within a district, moving schools between districts, switching to general education, or leaving teaching in the state) was associated with two common indicators of teacher quality: value-added scores or teaching observation scores. On average, special educators’ probability of leaving teaching in the state declined as their value-added score increased, after accounting for the characteristics of teachers, their students, and their schools. Observation scores were similarly negatively associated with leaving and with moving within or between districts. Eight percent of special educators switched to general education positions, and the probability of switching was not associated with teachers’ value-added or observation scores. The author discusses the implications for ensuring schools retain effective special educators while noting the limitations of current measures of special educator quality used in practice.

Quality measures of virtual care in ambulatory healthcare environments: a scoping review

ObjectivesDelivery of virtual care increased throughout the COVID-19 pandemic and persisted after physical distancing measures ended. However, little is known about how to measure the quality of virtual care, as...

Establishing Quality and Outcome Measures for Recovery Housing: A Tiered Approach Supporting Service Evolution.

With over one-hundred thousand drug overdose deaths in 2021, substance use disorder (SUD) is a public health crisis in the United States. Medical stabilization has been the predominant focus of SUD interventions despite low levels of retention. Consequently, national quality measures for SUD care outside the clinical continuity of care are limited. The expansion of recovery support services addressing social drivers of health outside clinical settings is needed. The current SUD quality measures are not applicable nor feasible for recovery support service providers with limited resource capacities, like the estimated 17,900 recovery housing providers nationwide. Despite widespread support for recovery housing and its documented effectiveness, no universal set of measures has been developed for widespread adoption. In this brief, a matrix of quality measures are proposed to meet the needs of recovery housing providers with various capacities to support service evolution and improve equitable SUD treatment and recovery care.

Patient-Centered Quality Measures for Dialysis Care: A Report of a Kidney Disease Outcomes Quality Initiative (KDOQI) Scientific Workshop Sponsored by the National Kidney Foundation

Providing high-quality patient-centered care is the central mission of dialysis facilities. Assessing quality and patient-centeredness of dialysis care is necessary for continuous dialysis facility improvement. Based predominantly on readily measured items, current quality measures in dialysis care emphasize biochemical and utilization outcomes, with very few patient-reported items. Additionally, current metrics often do not account for patient preferences and may compromise patient-centered care by limiting the ability of providers to individualize care targets, such as dialysis adequacy, based on patient priorities rather than a fixed numerical target. Developing, implementing, and maintaining a quality program using readily quantifiable data while also allowing for individualization of care targets that emphasize the goals of patients and their care partners provided the motivation for a September 2022 Kidney Disease Outcomes Quality Initiative (KDOQI) Workshop on Patient-Centered Quality Measures for Dialysis Care. Workshop participants focused on 4 questions: (1) What are the outcomes that are most important to patients and their care partners? (2) How can social determinants of health be accounted for in quality measures? (3) How can individualized care be effectively addressed in population-level quality programs? (4) What are the optimal means for collecting valid and robust patient-reported outcome data? Workshop participants identified numerous gaps within the current quality system and favored a conceptually broader, but not larger, quality system that stresses highly meaningful and adaptive measures that incorporate patient-centered principles, individual life goals, and social risk factors. Workshop participants also identified a need for new, low-burden tools to assess patient goals and priorities.

Adult Congenital Heart Disease Care in Canada: Has Quality of Care Improved in the Last Decade?

BackgroundPatients with adult congenital heart disease (ACHD) are at increased risk of comorbidity and death compared with the age-matched population. Specialized care is shown to improve survival. The purpose of this study was to analyze current measures of quality of care in Canada compared with those published by our group in 2012. MethodsA survey focusing on structure and process measures of care quality in 2020 was sent to 15 ACHD centres registered with the Canadian Adult Congenital Heart Network. For each domain of quality, comparisons were made with those published in 2012. ResultsIn Canada, 36,708 patients with ACHD received specialized care between 2019 and 2020. Ninety-five cardiologists were affiliated with ACHD centres. The median number of patients per ACHD clinic was 2000 (interquartile range [IQR]: 1050, 2875). Compared with the 2012 results, this represents a 68% increase in patients with ACHD but only a 19% increase in ACHD cardiologists. Compared with 2012, all procedural volumes increased with cardiac surgeries, increasing by 12% and percutaneous intervention by 22%. Wait time for nonurgent consults and interventions all exceeded national recommendations by an average of 7 months and had increased compared with 2012 by an additional 2 months. Variability in resources were noted across provincial regions. ConclusionsOver the past 10 years, ACHD care gaps have persisted, and personnel and infrastructure have not kept pace with estimates of ACHD population growth. Strategies are needed to improve and reduce disparity in ACHD care relative to training, staffing, and access to improved care for Canadians with ACHD.

A scoping review of heart failure transitional care quality indicators and outcomes for use in clinical care and research.

There are no accepted quality indicators for transitional care following hospitalization for heart failure (HF). Current quality measures focus on 30-day readmissions without accounting for competing risks such as death. In this scoping review of clinical trials, we aimed to develop a set of HF transitional care quality indicators for clinical or research applications following hospitalization for HF. We performed a scoping review using MEDLINE, Embase, CINAHL, HealthSTAR, reference lists and grey literature from January 1990 to November 2022. We included randomized controlled trials (RCTs) of adults hospitalized for HF who received a healthcare service or strategy intervention that aimed to improve patient-reported or clinical outcomes. We independently extracted data and performed a qualitative synthesis of the results. We generated a list of process, structure, patient-reported, and clinical measures that could be used as quality indicators. We highlighted process indicators that were associated with improved clinical outcomes and patient-reported outcomes that had high adherence to COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and United States Federal Drug Administration (FDA) standards. From 42 RCTs included in the study, we identified a set of process, structure, patient-reported, and clinical indicators that could be used as transitional care measures in clinical or research settings. In this scoping review, we developed a list of quality indicators that could guide clinical efforts or serve as research endpoints in transitional care in HF. Clinicians, researchers, institutions, and policymakers can use the indicators to guide management, design research, allocate resources, and fund services that improve clinical outcomes.

A new quality measure for acceptance and payment with a QC/QA performance specification using Bayesian updating

PurposeThis paper introduces a novel quality measure, the percent-within-distribution, or PWD, for acceptance and payment in a quality control/quality assurance (QC/QA) performance specification (PS).Design/methodology/approachThe new quality measure takes any sample size or distribution and uses a Bayesian updating process to re-estimate parameters of a design distribution as sample observations are fed through the algorithm. This methodology can be employed in a wide range of applications, but the authors demonstrate the use of the measure for a QC/QA PS with upper and lower bounds on 28-day compressive strength of in-place concrete for bridge decks.FindingsThe authors demonstrate the use of this new quality measure to illustrate how it addresses the shortcomings of the percent-within-limits (PWL), which is the current industry standard quality measure. The authors then use the PWD to develop initial pay factors through simulation regimes. The PWD is shown to function better than the PWL with realistic sample lots simulated to represent a variety of industry responses to a new QC/QA PS.Originality/valueThe analytical contribution of this work is the introduction of the new quality measure. However, the practical and managerial contributions of this work are of equal significance.

Quality Control Strategy and Evaluation Algorithm for Noncontact Instrument Testing

The test quality of noncontact instruments is an important issue that has aroused social concern at present, which is also widely used in the power quality management of telecommunication systems. The fuzzy logic algorithm can be used in power quality testing to analyze the power quality of electrical equipment. Based on the advantage of the fuzzy logic algorithm, this paper studied the quality control strategy and evaluation algorithm of noncontact instrument testing and drew a conclusion. In terms of the investigation on the safety of power quality measurement, it was concluded that the method of noncontact instrument testing power quality improved the safety of voltage quality, current quality, power supply quality, and power consumption quality. In the investigation of the accuracy of the power quality measurement, it was concluded that the noncontact instrument was used to measure power quality, which greatly improved the accuracy of measurement. In terms of the investigation on the rapidity of the power quality measurement, it was concluded that the use of the noncontact instrument to test power quality could greatly improve the rapidity of current quality measurement and that the rapidity of the power quality measurement could be improved by more than 70%. In the aspect of economic investigation of the power quality measurement, it was concluded that the use of the noncontact instrument to test power quality could greatly improve the economic efficiency of the power quality measurement. In the aspect of fuzzy logic evaluation in power quality management, it was concluded that most of the power quality grades of the selected research objects were excellent. Therefore, the fuzzy logic method was very meaningful for power quality evaluation.

It is time for a new comprehensive medication review quality measure.

Medication therapy management (MTM) services include comprehensive medication reviews (CMRs), which have been completed with millions of patients since their inception in the United States. The current MTM quality measure focuses on whether CMRs were completed (ie, the CMR completion rate). However, this process measure does not assess quality of care, or patient-reported or other outcomes of CMRs, and, therefore, does not reward MTM providers for improving health outcomes. In this viewpoint article, we present 3 reasons that shape our argument for new MTM quality measures and offer recommendations on next steps to achieve this. DISCLOSURES: Dr Vaffis is an employee of Clinical Outcomes Solutions and discloses this was work was completed previously during her employment at the University of Arizona. Dr Dhatt is an employee of Janssen and discloses this was work was completed previously during her employment at the University of Arizona. Dr Anderson is an employee of The Freedom Fund and discloses this was work was completed previously during her employment at the University of Arizona. Dr Black is an employee of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. Dr Campbell received funding from Pharmacy Quality Alliance, Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA, and SinfoniaRx and discloses this work was completed previously during his employment at the University of Arizona. Dr Kolobova is an employee of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. Dr Hines is an employee of Pharmacy Quality Alliance. Dr Castora-Binkley is an employee of Pharmacy Quality Alliance. Dr Nelson is an employee of Pharmacy Quality Alliance. Dr Axon received funding from Pharmacy Quality Alliance, Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA, and SinfoniaRx. Dr Warholak received funding from Pharmacy Quality Alliance, Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA, and SinfoniaRx and discloses this was work was completed previously during her employment at the University of Arizona.

Hidden Otolaryngology Malpractice Claims: An Internal Review From 2000 to 2020.

To report key characteristics and patterns of captive insurance claims not publicly reported in otolaryngology across a large tertiary-level academic health system over the previous 2 decades. Case series. The tertiary care health system. The internal captive insurance database at a tertiary level healthcare system was queried to identify otolaryngology-related malpractice claims regardless of final disposition (settled or dismissed) filed from 2000 to 2020. The date of the incident, date of claim, error type, patient outcome, provider subspecialty, total expenses, disposition, and final reward amount were recorded. Twenty-eight claims were identified. There were 11 (39.3%) claims from 2000 to 2010 and 17 (60.7%) claims from 2011 to 2020. Head and neck surgery was the most frequently implicated subspecialty (n = 9, 32.1% of all cases), followed by general otolaryngology (n = 7, 25.0%), pediatrics (n = 5, 17.9%), skull base/rhinology (n = 4, 14.3%), and laryngology (n = 1, 3.6%). Improper surgical performance was cited in 35.7% of cases (n = 10), followed by failure to diagnose (n = 8, 28.6%), to treat (n = 4, 14.3%), and to obtain informed consent (n = 3, 10.7%). While 2 cases are ongoing, a total of 17/26 (65.4%) cases were settled and 20/26 (76.9%) dismissed some or all parties. Dismissed claims had significantly higher expenses (p = .022) and duration from incident to disposition (p = .013) compared to settled claims. This study expands the malpractice landscape in otolaryngology by including data not readily available through public sources and compares it to national trends. These findings encourage otolaryngologists to better gauge current quality and safety measures that best protect patients from harm.

KUALITAS PELAYANAN DALAM MENINGKATKAN MINAT BELI KONSUMEN DI INDOMARET JAHARUN A GALANG

Service quality is one of the important determinants to maintain a company's businessperformance. Quality service can make customers satisfied which is very beneficial for thecompany. One of the companies that need to provide quality services is Indomaret. Serviceproblems at Indomaret occur because of the bad experience of consumers which causes customersto be disappointed. Companies need to improve their service performance to close the gaps thatoccur so that this problem does not have a bad impact on business performance. In order toprovide quality services, companies need to know the current quality measures and performancepriorities for improvement to increase customer satisfaction. Therefore, this research method usesinterview techniques with consumers in Indomaret as research informants. The results showed asignificant and positive effect of perceived service quality on various satisfaction and repurchaseintentions, the perceived value had a significant and positive effect on increasing consumer buyinginterest in Indomaret.Keywords: Service Quality, Purchase Interest, Consumer

Physical activity and diet associations with the gut microbiota in the Coronary Artery Risk Development in Young Adults (CARDIA) study

BackgroundGut microbiota may influence metabolic pathways related to chronic health conditions. Evidence for physical activity and diet influences on gut microbial composition exists, but data from diverse population-based cohort studies are limited. ObjectivesWe hypothesized that gut microbial diversity and genera are associated with physical activity and diet quality. MethodsData were from 537 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) Study, a prospective cohort, who attended the year 30 follow-up examination (2015–2016; aged 47–61 y; 45% Black race/55% White race; 45% men/55% women). The 16S ribosomal RNA marker gene was sequenced from stool DNA, and genus-level taxonomy was assigned. Within-person microbial diversity (α-diversity) was assessed with Shannon diversity index and richness scores; between-person diversity (β-diversity) measures were generated with principal coordinates analysis (PCoA). Current and long-term physical activity and diet quality measures were derived from data collected over 30 y of follow-up. Multivariable-adjusted regression analysis controlled for: sociodemographic variables (age, race, sex, education, and field center), other health behaviors (smoking, alcohol consumption, and medication use), and adjusted for multiple comparisons with the false discovery rate (<0.20). ResultsBased on PCoA β-diversity, participants’ microbial community compositions differed significantly (P < 0.001), with respect to both current and long-term physical activity and diet quality. α-Diversity was associated only with current physical activity (positively) in multivariable-adjusted analysis. Multiple genera (n = 45) were associated with physical activity and fewer with diet (n = 5), including positive associations with Lachnospiraceae UCG-001 and Ruminococcaceae IncertaeSedis with both behaviors. ConclusionsPhysical activity and diet quality were associated with gut microbial composition among 537 participants in the CARDIA study. Multiple genera were associated with physical activity. Physical activity and diet quality were associated with genera consistent with pathways related to inflammation and short-chain fatty acid production.

P093Patient-centered metrics for quality of reproductive healthcare

<h3>Objectives</h3> Current measures of quality of reproductive healthcare, such as rates of unintended pregnancy and contraceptive uptake, neglect to incorporate patients' lived experiences and reproductive autonomy. We sought to explore alternative metrics that center patient preferences. <h3>Methods</h3> We conducted five focus groups and eight interviews with participants (n=30), who identified as women, were aged 18–45, lived in New York State, and had visited a primary care provider in the last year, recruited from a third-party firm. The guides asked about ideal clinical interactions when preventing or planning pregnancy and measuring the quality of such interactions. We queried for using reproductive autonomy as a measure, defined as "whether the patient got the reproductive health service or counseling that they wanted to get, while having all the information about and access to their options, and not feeling forced into anything." <h3>Results</h3> Participants wanted care that was non-judgmental and respectful. Desires for discussions on preventing compared to planning pregnancy were qualitatively distinct. For prevention, many preferred unbiased information about contraceptive options to help make their own decisions. For pregnancy planning, many desired comprehensive information and provider input and support throughout their pregnancy. Although collaboration was desired for both, for contraceptive use, participants perceived themselves as the ultimate decision maker. There was considerable support for using reproductive autonomy as a measure of quality. <h3>Conclusions</h3> Patients had distinct desires in their preferred approach to discussions about preventing versus planning pregnancy. Reproductive autonomy may be a superior metric for quality of reproductive healthcare generally.

Method to quantify the impact of sleep on cardiac neuroautonomic functionality: application to the prediction of cardiovascular events in the Multi-Ethnic Study of Atherosclerosis.

We introduce the concept of cardiac neuroautonomic renewability and a method for its quantification. This concept refers to the involuntary nervous system's capacity to improve cardiac control in response to restorative interventions, such as sleep. We used the change in heart rate fragmentation (ΔHRF), before sleep onset compared with after sleep termination, to quantify the restorative effects of sleep. We hypothesized that the ability to improve cardiac neuroautonomic functionality would diminish with age and be associated with lower risk of major adverse cardiovascular events (MACE). We analyzed the ECG channel of polysomnographic recordings from an ancillary investigation of the Multi-Ethnic Study of Atherosclerosis (MESA). In a cohort of 659 participants (mean ± SD age, 69.7 ± 8.8; 42% male), HRF was significantly (P < 0.001) lower after sleep (before: 74 ± 12%, after: 67 ± 13%). Furthermore, the magnitude of the decrease significantly (P < 0.001) diminished with cross-sectional age. In addition, a larger reduction in HRF following sleep (i.e., higher ΔHRF) was associated with lower risk of MACE, independent of traditional cardiovascular risk factors and current measures of sleep quality. Specifically, over a mean follow-up period of 6.4 ± 1.6 yr, in which 60 participants had their first MACE, a one-SD (12%) increase in ΔHRF was associated with a 36% (95% CI: 12%-53%) decrease in the risk of MACE. The results demonstrate the restorative impact of sleep on heart rate control. As such they support the concept of cardiac neuroautonomic renewability and the utility of ΔHRF for its quantification.

Limitations to Health Care Quality Measurement: Assessing Hospital Variation in Risk of Cardiac Events After Noncardiac Surgery.

Limited sample size, incomplete measures, and inadequate risk adjustment adversely influence accurate health care quality measurements, surgical quality measurements, and accurate comparisons among hospitals. Since these measures are linked to resources for quality improvement and reimbursement, improving the accuracy of measurement has substantial implications for patients, clinicians, hospital administrators, insurers, and purchasers. The team examined risk-adjusted differences of postoperative cardiac events among 20 geographically dispersed, community-based medical centers within an integrated health care system and compared it with the National Surgical Quality Improvement Program (NSQIP) hospital-specific differences. The exposure included the hospital at which patients received noncardiac surgical care, with stratification of patients by the acuity of surgery (elective vs. urgent/emergent). Among 157,075 surgery patients, the unadjusted risk of cardiac event per 1000 ranged among hospitals from 2.1 to 6.9 for elective surgery and from 10.3 to 44.5 for urgent/emergent surgery. Across the 20 hospitals, hospital rankings estimated in the present analysis differed significantly from ranking reported by NSQIP (P for difference: elective, P = 0.0001; urgent/emergent, P < 0.0001) with significantly and substantially lower variation after risk adjustment. Current surgical quality measures may not adequately account for limitations of sample size, data capture, adequate risk adjustment, and surgical acuity in a given hospital, particularly for rare outcomes. These differences have implications for quality reporting and may introduce bias into hospital comparisons, particularly for hospitals with incomplete capture of their patients' baseline risk and acuity.

Retina-based quality assessment of tile-coded 360-degree videos

Nowadays, omnidirectional content, which delivers 360-degree views of scenes, is a significant aspect of Virtual Reality systems. While 360 video requires a lot of bandwidth, users only see visible tiles, therefore a large amount of bitrate can be saved without affecting the user’s experience on the service. The fact leads to current video adaptation solutions to filter out superfluous parts and extraneous bandwidth. To form a good basis for these adaptations, it is necessary to understand human’s video quality perception. In our research, we contribute to building an effective omnidirectional video database that can be applied to study the effects of the five zones of the human retina. We also design a new video quality assessment method to analyze the impacts of those zones of a 360 video according to the human retina. The proposed scheme is found to outperform 22 current objective quality measures by 11 to 31% in terms of the PCC parameter.

After Childbirth: Better Data Can Help Align Postpartum Needs with a New Standard of Care.

After Childbirth: Better Data Can Help Align Postpartum Needs with a New Standard of Care.

Should We Consider Including a Value for “Hope” as an Additional Benefit Within Health Technology Assessment?

Health technology assessment (HTA) typically uses average health-related quality of life gain as its main measure of benefit used in economic evaluation. Nevertheless, there have been calls to consider novel aspects of benefit including the "value of hope," defined as a patients' potential preferences for a wider distribution of treatment benefit with a positive skew, in the hope that they will be one of the lucky ones. The value of hope may also derive from feeling hopeful as a positive mental state, which may be missing from current measures of health-related quality of life. The value attributed to feeling hopeful could be related to, or additional to, the value derived from possible risk-seeking preferences. Here, we reflect upon the strength of the case for the inclusion of the "value of hope" taking a critical look at the commonly referenced evidence for including the "value of hope" as risk-seeking preferences. We also draw attention to other conceptions of hope-as an emotion, a cognitive process, or a combination of both-and reflect upon the potential of including these broader notions of hope into HTA. The case for the inclusion of the "value of hope" based on risk-seeking preferences is weak. We suggest research questions that could give further evidence on whether hope is an important missing value from HTA.

ASCP, PQA, and AMDA: A Collaboration Using Quality Measures to Advocate for Best Senior Care

View Large Image Figure ViewerDownload Hi-res image Download (PPT)The American Society of Consultant Pharmacists (ASCP) is a membership association that was founded in 1969 to represent pharmacists and other health care professionals who work with older adults. ASCP’s mission is “to promote healthy aging by empowering pharmacists with education, resources, and innovative opportunities” (“ASCP: Empowering Pharmacists; Transforming Aging,” https://www.ascp.com/page/about). The Pharmacy Quality Alliance (PQA) is a nonprofit and consensus-based “national quality organization dedicated to improving medication safety, adherence, appropriate use” (“About PQA,” https://www.pqaalliance.org/our-story). They provide medication management services through performance measurement, research, and education, and are in a public-private partnership with the Centers for Medicare & Medicaid Services (see “PQA Measure Development Process, Version 4.0,” Oct. 25, 2021, https://bit.ly/369SPRx). The relationships between PQA and ASCP and between ASCP and AMDA – The Society for Post-Acute and Long-Term Care Medicine highlight the benefits of collaboration to optimize patient care. By aligning the clinical and financial goals among these organizations to improve outcomes, this model of collaboration has demonstrated its value for successful results. As a PQA member organization, ASCP works with PQA in multiple ways. ASCP contributes subject matter expertise during measure development and maintenance. ASCP also serves in an advisory role as measures are vetted and finalized for adoption to support measure implementation strategies via its professional relationships. ASCP’s interest in promoting adoption of measures is inclusive of the regulatory level by government agencies and at the grassroots level with allied pharmacy organizations and their membership. ASCP’s consultant pharmacists partner with other ASCP members and any aligned health care team members, including facility data collection providers (e.g., Minimum Data Set [MDS] coordinators) to ensure education about measures and accuracy in the data coding process. Additionally, they provide traditional medication regimen review services, comprehensive medication reviews for Medicare D beneficiaries in post-acute and long-term care, additional residential care settings, and novel emerging community and telehealth practices. One example of how ASCP has collaborated with PQA to provide subject matter expertise on a specific PALTC concern is the “Antipsychotic Use in Persons with Dementia (APD)” measure, which “evaluates the percentage of individuals with dementia with a prescription claim for an antipsychotic medication without evidence of a psychotic disorder or related condition.” It was also “adapted for the long-term care setting using MDS data” (“PQA Measures Overview,” Sept. 23, 2021, https://bit.ly/3oUKx6w). ASCP also collaborated with PQA to understand the intent of the current APD quality measure and identify opportunities for continued quality improvement, which informed ASCP’s policy and position statement on the “Use of Antipsychotic Medications in Nursing Facility Residents” (Apr. 1, 2018, https://bit.ly/3HZLH8u). The position statement aligns the partnership and mission of ASCP with that of AMDA. ASCP members work closely with their facility clients at the corporate ownership, medical leadership, and administrative executive levels to complement the entity’s focus on quality measures. ASCP consultant pharmacists, ASCP member provider pharmacies, and pharmacy managed care organizations ensure alignment with these mutual goals. They work side by side with the Society’s members to ensure that quality measures are shared, strategized, and implemented to ensure individual providers are held accountable for meeting the goals. Finally, the partnership between ASCP and the Society uses publicly collected data on outcomes statistics related to the measures and compares performance with benchmark state and national averages. Data indicators of poor performance become a focus for attention, including the use of vehicles such as facility Quality Assurance Performance Improvement (QAPI) activities. “PQA’s mission to optimize health by advancing the quality of medication use is supported by collaboration with ASCP,” said PQA Chief Quality and Innovation Officer Lisa Hines, PharmD, CPHQ. “Our work together and ASCP’s collaboration with AMDA enhances our strategies and ability to promote safe and appropriate medication use for older adults.” The information presented is a selective summary of publicly available information and is accurate as of the date of writing. Please consult the sources for complete reference information. Dr. Manzi has been a licensed pharmacist since 1990 and a Board Certified Geriatric Pharmacist since 1998. She is the director of LTC clinical services at Managed Health Care Associates, Inc. The views expressed in this article are those of the author(s) alone and not of Managed Health Care Associates, Inc. Robert C. Accetta is the president/owner of Rivercare Consulting, LLC. A Board-Certified Geriatric Pharmacist, Rob currently serves on the Board of Directors of the American Society of Consultant Pharmacists (ASCP). He is a graduate of St. John’s University College of Pharmacy and Health Sciences in New York.

A statistical alternative to current measures of image quality in digital mammography

Objective. Mammogram image quality in European breast screening systems is defined by threshold gold thickness (T) assessment of the CDMAM contrast-detail phantom. Previous studies have outlined several limitations of the phantom including expense, number of images required and inter-phantom manufacturing variability. Two alternative approaches to image quality assessment for routine quality control are examined and compared to the CDMAM technique: (i) A detectability index (d′) based on a non-prewhitened model observer with an eye filter (NPWE) and (ii) A statistical estimate of contrast based on image noise levels (CSTAT ). Approach. The d′ calculation follows a previously published methodology based on the NNPS and contrast, both measured from an image of 5 cm of PMMA containing a 0.2 mm Al target, as well as the MTF measured under standard conditions. For the proposed statistical method, pixels in the centre of the same NNPS image were re-binned into a range of equivalent CDMAM target areas. For any area, the minimum contrast necessary to distinguish a signal from the background, CSTAT , is 3.29σ at a 95% level of confidence, where σ is the standard deviation of the background pixels. Theoretical analysis predicts a simple relationships between CSTAT , T and d′. Measured values of CSTAT were compared to T and d′ as a function of air kerma at the detector for ten digital mammography systems from three different manufacturers. Main Results. Theoretical relationships between CSTAT , d′ and T were demonstrated. Minimum acceptable image quality performance for 0.10 and 0.25 mm diameter discs, defined by the European Guidelines in terms of T, are equivalent to d′ values of 0.85 and 5.36 and threshold CSTAT values of 0.055 and 0.022. Significance. Strong correlations between log(T), log(d′) and log(CSTAT ) suggest that either alternative approach produces information corresponding to that obtained using the CDMAM. CSTAT should be considered as a simple, objective and cost-effective alternative to routine image quality assessment in mammography.